"Why Parents Of Young Children With ADHD May Want To Delay Medication Until Their Kids Are Older"

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The New York Times recently reported that rates of ADHD diagnosis among school-aged children has risen to 11 percent — a record high. That number is partially a consequence of more accurate ADHD diagnoses — but it presents a stark choice for parents debating the best treatment options for their kids. Medications such as Adderall and Ritalin are a common choice — but a new analysis of previous ADHD studies suggests behavior training “that teaches parents to understand their children’s needs” might be a better long-term care option for young children.

The new study, led by Dr. Alice Charach of the Hospital for Sick Children in Toronto, examined eight past analyses on the effect that parental behavior training “which consists of about 10 to 12 sessions that teach parents how to better understand their child” had on preschoolers with ADHD. Those studies found that the parent-oriented treatment led to about the same behavioral improvement in children as medication, but without causing the negative side effects associated with ADHD drug use by young kids:

“The main thing is really helping the parent understand their child and read their child,” [Charach] said.

For example, the sessions may help parents understand their child acts up after an hour of being at a birthday party, and that they should leave earlier.

Only one “good” study evaluated Ritalin use in preschoolers. That study showed a similar improvement in behavior, but the preschoolers were at risk for side effects, including irritability and slowed growth.

“For whatever reason children in this age group are more sensitive to the Ritalin side effects,” said Charach.

Questions surrounding the long-term efficacy of ADHD medications have stirred debate among pediatricians and psychiatrists. In a 2012 editorial for the New York Times, a professor emeritus of psychology at the University of Minnesota’s Institute of Child Development argued that there is considerable evidence showing that medication was effective in the short-term, but “after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.”

Early intervention by parents trained to approach their children in an appropriate way could end up being more beneficial in the long term, and could be particularly effective in a regimen that also includes medications if necessary. That’s particularly important considering that ADHD has lingering long-term effects well past childhood and is a strong indicator of co-occurring mental illness in both adults and children.

Still, beneficial or not, the question of costs will weigh heavily on parents considering the potentially high out-of-pocket costs associated with the personalized training sessions. A combination of factors — including poor reimbursement rates by government insurance programs and private insurers to mental health care providers, as well as a lack of school-based resources for treating mental health — could price out parents looking to take advantage of this treatment approach.

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